The purpose of this pivotal study was to compare the efficacy of asciminib (ABL001) with that of bosutinib in the treatment of participants with chronic myeloid leukemia - chronic phase (CML-CP) having previously been treated with a minimum of two prior ATP-binding site tyrosine kinase inhibitors (TKIs).
Participants with a diagnosis of CML-CP who had received prior treatment with 2 or more ATP binding site TKIs and were treatment failure (as per guidelines adapted from the 2013 ELN recommendations) or intolerant to the most recent TKI. Participants were randomized in a 2:1 ratio to asciminib 40 mg BID or bosutinib 500 mg QD. Randomization was stratified by major cytogenetic response (MCyR) at screening. Participants with documented treatment failure (as per the 2013 ELN recommendations) while on bosutinib treatment were offered the option to switch to asciminib treatment within 96 weeks after the last patient was randomized to the study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
233
Major Molecular Response (MMR) Rate at 24 Weeks
MMR was defined as a ≥ 3.0 log reduction in BCR-ABL1 transcripts compared to the standardized baseline equivalent to ≤ 0.1% BCR-ABL1/ABL% by international scale (IS) as measured by RQ-PCR.
Time frame: 24 weeks
Major Molecular Response (MMR) Rate at 96 Weeks (Key Secondary Endpoint)
MMR at 96 weeks was defined as the percentage of participants with MMR at 96 weeks. MMR was defined as a ≥ 3.0 log reduction in BCR-ABL1 transcripts compared to the standardized baseline equivalent to ≤ 0.1% BCR-ABL1/ABL% by international scale (IS) as measured by RQ-PCR.
Time frame: 96 Weeks
Complete Cytogenetic Response (CCyR) Rate at Scheduled Time Points
Cytogenic response included Complete, Partial, Major, Minor, Minimal and no response. Cytogenetic response was assessed as the percentage of Ph+ metaphases in the bone marrow and is defined as the following: Complete (CCyR) - 0% Ph+ metaphases; Partial (PCyR) - \>0 to 35% Ph+ metaphases; Major (MCyR) - 0 to 35% Ph+ metaphases; Minor (mCyR) - \>35 to 65% Ph+ metaphases; Minimal - \>65 to 95% Ph+ metaphases; None - \>95 to 100% Ph+ metaphases.
Time frame: at 24, 48, 72, 96, 120 and 144 weeks
Complete Cytogenetic Response Rate by Scheduled Time Points
Cytogenic response included Complete, Partial, Major, Minor, Minimal and no response. Cytogenetic response was assessed as the percentage of Ph+ metaphases in the bone marrow and is defined as the following: Complete (CCyR) - 0% Ph+ metaphases; Partial (PCyR) - \>0 to 35% Ph+ metaphases; Major (MCyR) - 0 to 35% Ph+ metaphases; Minor (mCyR) - \>35 to 65% Ph+ metaphases; Minimal - \>65 to 95% Ph+ metaphases; None - \>95 to 100% Ph+ metaphases.
Time frame: by 24, 48, 72, 96, 120 and 144 weeks
Major Molecular Response (MMR) Rate at All Scheduled Data Collection Time Points Except Weeks 24 & 96
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University of Chicago Hospital
Chicago, Illinois, United States
Indiana Blood and Marrow Institute
Beech Grove, Indiana, United States
Sidney Kimmel Comprehensive Cancer Center
Baltimore, Maryland, United States
Dana Farber Cancer Center
Boston, Massachusetts, United States
University of Michigan Clinical Trials Office
Ann Arbor, Michigan, United States
Roswell Park Cancer Institute
Buffalo, New York, United States
Weill Cornell Medicine NY-Presb
New York, New York, United States
Memorial Sloan Kettering Cancer Ctr
New York, New York, United States
Uni Of TX MD Anderson Cancer Cntr
Houston, Texas, United States
Utah Huntsman Cancer Center
Salt Lake City, Utah, United States
...and 78 more locations
MMR was defined as a ≥ 3.0 log reduction in BCR-ABL1 transcripts compared to the standardized baseline equivalent to ≤ 0.1% BCR-ABL1/ABL% by international scale (IS) as measured by RQ-PCR.
Time frame: at Weeks 36, 48, 60, 72, 84, 108, 120, 132, 144 & 156
Major Molecular Response (MMR) Rate by All Scheduled Data Collection Time Points
MMR was defined as a ≥ 3.0 log reduction in BCR-ABL1 transcripts compared to the standardized baseline equivalent to ≤ 0.1% BCR-ABL1/ABL% by international scale (IS) as measured by RQ-PCR. Overall time point has the count indicating participants achieving MMR at any time during the study.
Time frame: by Weeks 4, 8, 12, 16, 24, 36, 48, 60, 72, 84, 96, 108, 120, 132, 144 & 156, Overall
Time to Major Molecular Response (MMR)
Time to MMR was defined as the time from the date of randomization to the date of the first documented MMR.
Time frame: 216 Weeks
Duration of Major Molecular Response (MMR)
Duration of MMR was defined as the time from the date of first documented MMR to the earliest date of loss of MMR, progression to Accelerated phase (AP) or Blast crisis (BC), or Chronic myeloid leukemia (CML)-related death.
Time frame: 216 Weeks
Time to Complete Cytogenetic Response Rate (CCyR) Among Participants Who Achieved CCyR
Time to CCyR was defined as the time from the date of randomization to the date of the first documented CCyR.
Time frame: 216 Weeks
Duration of Complete Cytogenetic Response (CCyR)
Duration of CCyR was defined as the time between date of first documented CCyR and the earliest date of loss of CCyR, progression to AP/BC, or CML-related death for participants in the Cytogenetic Responder Set. The time was censored at the last cytogenetic assessment date on treatment for participants for whom none of the events was reported or last PCR evaluation on treatment indicating MMR.
Time frame: 144 weeks
Time to Treatment Failure (TTF)
TTF was defined as the time from date of randomization to an event of treatment failure. Treatment failure was defined as meeting a lack of efficacy criterion or discontinuing treatment due to any reason.
Time frame: From the first dose of treatment up to 5 years, through treatment completion, an average of 2.3 years, approximately
Progression Free Survival Per Percentage Event-free Kaplan-Meier Estimates
Progression-free survival was defined as the time from the date of randomization to the earliest occurrence of documented disease progression to AP/BC or the date of death from any cause (including progressions and deaths observed during the survival follow-up period), per Kaplan-Meier.
Time frame: From the first dose of treatment up to study completion, up to 5 years
Overall Survival (OS) Per Event Free Percentage Per Kaplan-Meier Estimates
Overall survival is defined as the time from the date of randomization to the date of death (including the survival follow-up period) per Kaplan-Meier (KM).
Time frame: From the first dose of treatment to study completion, up to 5 years
Trough Plasma Concentrations for Asciminib
Measured concentration at the end of a dosing interval at steady state (taken directly before next administration)
Time frame: Week 2 Day 1 at: 0hr (pre-dose), 0.5hr, 1hr, 2hr, 3hr, 4hr, 6hr, 8hr & 12hr post-dose
PK Parameter: Cmax for Asciminib
Maximum (peak) observed plasma concentration after dose administration (mass x volume-1).
Time frame: Week 2 Day 1 at pre-dose, 0.5hr, 1hr, 2hr, 3hr, 4hr, 6hr, 8hr & 12hr post-dose
PK Parameter: Tmax for Asciminib
Time to reach maximum (peak) plasma concentration after dose administration (time). Actual sampling times were taken into consideration for the pharmacokinetic analysis.
Time frame: Week 2 Day 1 at: 0hr (pre-dose), 0.5hr, 1hr, 2hr, 3hr, 4hr, 6hr, 8hr & 12hr post-dose
PK Parameter: AUC0-12h for Asciminib
Area under the plasma concentration-time curve from time zero to 12 hours (mass x time x volume-1)
Time frame: Week 2 Day 1 at: 0hr (pre-dose), 0.5hr, 1hr, 2hr, 3hr, 4hr, 6hr, 8hr & 12hr post-dose
PK Parameter: CL/F for Asciminib
Total apparent body clearance of drug from the plasma after oral administration (volume x time-1).
Time frame: Week 2 day 1 at: 0hr (pre-dose), 0.5hr, 1hr, 2hr, 3hr, 4hr, 6hr, 8hr & 12hr post-dose